From the 1930s to the 1950s, ‘doctors’ once lit up the pages of cigarette advertisements.

In the grand scope of the history of medicine, the relationship between doctors and patients has changed quite a bit in recent years. The internet and direct-to-consumer advertising have empowered patients to become active participants in their health care. However, it was not always this way.

For a long time, physicians were the authority on health. Patients trusted in their doctors’ education and expertise and, for the most part, followed their advice. When health concerns about cigarettes began to receive public attention in the 1930s, tobacco companies took preemptive action. They capitalized on the public’s trust of physicians in order to quell concerns about the dangers of smoking. Thus was born the use of physicians in cigarette advertisements.

Photo courtesy of Dr. Robert K. Jackler, MD, and Stanford University

“When you knit this together into a full story, the scope of it and the way it duped the public was just incredible,” said Robert K. Jackler, MD, Sewall Professor and Chair, otolaryngology – head and neck surgery at Stanford University Medical Center. “The public was becoming increasingly worried about the health consequences of cigarettes. They started to refer to cigarettes as coffin nails and started talking about smoker’s cough and smoker’s hack. The companies saw a threat to their success and business model.”

Executives at tobacco companies knew they had to take action to suppress the public’s fears about tobacco products. “Tobacco companies asked themselves: How can we go about reassuring the public that particularly cigarettes, but also cigars and pipes, are not harmful?” Jackler told HemOnc Today. The answer was to use medical research and physicians to show the public that cigarettes were not harmful. Although the doctors in these advertisements were always actors and not real physicians, the image of the physician permeated cigarette ads for the next two and a half decades.

Famous Campaigns

During the 1920s, Lucky Strike was the dominant cigarette brand. This brand, made by the American Tobacco Company, was the first to use the image of a physician in its advertisements. “20,679 physicians say ‘Luckies are less irritating,” its advertisements proclaimed. The advertising firm that promoted Lucky Strikes had sent physicians free cartons of the cigarettes and asked them whether Lucky Strikes were less irritating to ‘sensitive and tender’ throats. The company claimed that its toasting process made its cigarettes a smoother smoke.

By the mid-1930s, Lucky Strike had some competition. A new advertising campaign for Philip Morris referred to research conducted by physicians. One ad claimed that after prescribing Philip Morris brand cigarettes to patients with irritated throats, “every case of irritation cleared completely or definitely improved.” This series of advertisements, along with others referring to “proof” of superiority, made Philip Morris a major cigarette brand for the first time in its history.

“There was an interesting paradox in the ads. In one ad a company would say cigarettes aren’t harmful and then in other ads, they would say our cigarettes are less harmful than the other brands,” Jackler said. “You would get things like ‘not one case of throat irritation’ with a picture of a throat doctor holding a throat mirror wearing a mirror on his forehead.”

Photo courtesy of Dr. Robert K. Jackler, MD, and Stanford University

One of the most famous of the campaigns of this era was the “More Doctors” campaign for RJ Reynolds Tobacco Company’s Camels brand cigarettes. These ads, which appeared in magazines from Time to Ladies’ Home Journal, claimed that according to a nationwide survey, “More doctors smoke Camels than any other cigarette!” These ads pictured doctors in labs, sitting back at their desk or speaking with patients. “The idea was that if you show a physician being an enthusiastic partaker in smoking, the public gets the notion, ‘With what doctors know, if they choose to smoke this brand it must be a safer, better brand,’ or the public thought that smoking itself must be OK,” Jackler said.

Flip Side Of The Coin

Physicians were also not immune to the addictions of cigarettes and tobacco products and tobacco companies knew it. Many physicians still doubted that there was a wide-spread connection between smoking and disease. Instead, it was believed that only certain individuals’ health was affected by smoking; it was thought to be a case-by-case situation.

Tobacco companies targeted this thought process by telling physicians that if patients are going to smoke cigarettes regardless of what was advised for their health, at least prescribe for them a ‘healthier’ brand of cigarettes.

“There were big ad campaigns with hundreds of ads in medical journals,” Jackler said. “For example, there is an ad showing a physician writing on a prescription pad, ‘For your patients with sore throats and cough, Phillip Morris cigarettes.’”

The pages of The New England Journal of Medicine and The Journal of the American Medical Association were home to many tobacco advertisements throughout the 1930s, 1940s and beyond. However, tobacco companies’ courtship of physicians did not end in medical journals.

Photo courtesy of Dr. Robert K. Jackler, MD, and Stanford University

“Cigarette companies also wanted doctors to smoke their brands,” Jackler said. Companies like Phillip Morris and RJ Reynolds participated in medical conventions by sponsoring doctors’ lounges and giving away free cigarettes. But the most inventive method to influence physicians was RJ Reynolds’s creation of its Medical Relations Division. This ‘division’ was based out of an RJ Reynolds advertising firm and focused on promoting Camels cigarettes by finding researchers who could substantiate the medical claims that the company was making in advertisements. Now the company was able to refer to research findings in their advertisements, both to consumers and to physicians.

Giving Up The Fight

In the late 1940s and early 1950s, a transition began to appear in these ads. Advertisements for Camels began to incorporate a ‘try it for yourself’ approach. Although the ads still pictured physicians proclaiming cigarettes to be less irritating, they also now encouraged consumers to test the cigarettes themselves:

“The test was really fun! Every Camel tasted so good! And I didn’t need my doctor’s report to know Camels are mild!”

But it was only a matter of time until science caught up to the advertising. By the mid-1950s more research was being published that confirmed a link between tobacco products and lung cancer. Growing concerns among the public about the dangers of smoking cigarettes meant the slow disappearance of the ‘physician’ from cigarettes ads. Slowly, the tobacco companies began to band together as they realized that their entire industry was in danger.

Photo courtesy of Dr. Robert K. Jackler, MD, and Stanford University

By 1953, JAMA banned tobacco ads from its pages and from AMA conventions. Other advertisers in the publication disliked having their ads placed by ads for cigarettes. Physicians also began to give up the habit. A study published in The New England Journal of Medicine in 1959 found that the number of physicians in Massachusetts who reported being regular smokers declined from 52% in 1954 to 39% in 1959.

The Proof

On Jan. 11, 1964, Surgeon General Luther Terry announced the findings of the Surgeon General’s Advisory Committee on Smoking and Health. The report, Smoking, and Health: Report of the Advisory Committee to the Surgeon General of the United States concluded that there was a link between lung cancer and chronic bronchitis and cigarette smoking. In a press conference, Terry said, “It is the judgment of the committee that cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate.” By the end of 1965, the tobacco industry was required to put warning labels on its products and advertisements to warn the public of the health risks associated with smoking.

After a couple hundred years of tobacco use, tobacco companies would lose several more major battles throughout the next few decades, including the ban on television ads in 1970 when Richard Nixon signed the Public Health Cigarette Smoking Act. In 2005, tobacco companies made a settlement with the National Association of Attorneys General that included an agreement to remove tobacco ads from the school library editions of Time, People, Sports Illustrated and Newsweek.
Despite all this, about 45 million Americans still smoke. Although the CDC estimates that tobacco use decreased by almost one-third between 1990 and 2007, it is estimated more than 400,000 people still die before their time as a result of tobacco products.

For more information:

1. For more images on physicians in cigarette advertisements visit: http://lane.stanford.edu/tobacco.
2. Am J Public Health. 2006;96: 222-231.
3. J Natl Cancer Inst. 1994;86: 1048-1049.
4. N Engl J Med. 1959;261: 603-604.